Published: Sunday, January 26, 2014 at 6:54 p.m.

Last Modified: Sunday, January 26, 2014 at 6:54 p.m.

SARASOTA - Terry Nicholson started working for Clockwork Home Services Inc. when the company consisted of four men, a single desk and a few folding chairs in a dusty little St. Louis office.

Nicholson helped make the provider of air conditioning, plumbing and electrical services a national brand. Eventually, it was sold for $183 million to power company Direct Energy Services.

Nicholson and a team of brand builders are building again. Only this time they have set their sights even higher -- expanding a national health care franchise that they project will generate $3.2 billion over the next decade.

Nicholson and his partners are confident their new FYZICAL Therapy and Balance Centers franchise will become the McDonald's of the physical- therapy business. At the same time, they are determined to change the way health care is viewed in America.

"We're off to a fast start, and we have very ambitious growth goals," Nicholson said from the company's headquarters in the Burns Square area of Sarasota.

"We intend to change the industry. And I think we even have an outside chance to change the way health care is done entirely."

The partners hope their new franchise will help independently owned physical-therapy clinics grow the same way Clockwork helped plumbers and electricians across the country.

If projections hold, they could do just that. The global health care services market is forecast to reach $3 trillion by 2015, according to research from Global Industry Analysts.

Thanks to an aging world population, the demand for health care is likely to continue climbing in years to come. As that occurs, the industry's focus is expected to shift to preventative care.

"Physical therapy is evolving -- the more people we can get to understand their bodies better, the more injuries we can prevent," said Tad Fisher, CEO of the Florida Physical Therapy Association.

"The focus is on how to keep bodies from breaking down, and that will drive costs down."

Filling a need

Nicholson said he and his partners chose physical therapy because they believe the industry -- and the entire health care system -- are broken.

He points to statistics that show two-thirds of Americans are considered overweight, one-third are clinically obese, and 1.5 million people in the U.S. die each year from preventable illness.

Each person who makes up those statistics represents a potential customer for FYZICAL.

The physical therapy business currently relies on a model that is based on reimbursements from insurance companies for back-end treatment.

But both Medicare and private insurers are cutting back on reimbursements, even as regulations stiffen, costs rise and competition from hospitals and other physicians groups increases.

That has left the physical-therapy industry -- with clinics overwhelmingly run by smaller shops -- struggling to stay afloat.

Nicholson believes creating a unified brand that shifts the focus to a cash-based model for such treatments is the answer.

"This is a fragmented industry that's composed of a bunch of independents," he said. "We have a business strategy we can apply. Physical-therapy school didn't teach them how to solve business challenges.

"That's what we're good at -- taking these independents and making them business masters."

By shifting to a cash-based business model, the company hopes to capture more retiring baby boomers, who are living longer, are generally affluent and more active and are willing to pay for prevention through fitness rather than rehab a costly injury like a broken hip.

Nicholson predicts insurers will eventually follow and fund preventative care to give people an incentive to be healthy.

That is how most employer-based insurers now see the dental industry, which offers preventative teeth cleanings for nominal costs but charges higher consumer deductibles for treatments like oral surgery.

Research shows, too, that many consumers do not seem to mind paying out of pocket for services such as teeth whitening, Invisalign braces or porcelain crowns.

To apply the dental services model to physical therapy, FYZICAL plans to generate increased revenue by opening a series of physical-therapy-based retail shops, which will sell everything from bottled water to protein bars and sweat bands. The company also has developed a new $159 muscular and skeletal exam to get patients in the door.

Nicholson hopes those strategies will help bolster bottom lines for physical-therapy clinics, which average just $358,000 in annual revenue, records show.

"America is an aging population, but these retirees are not like my grandma and grandpa," Nicholson said. "They want to live longer, they're active and they spend more to remain healthy. They're willing to invest money to ensure they live the life-style they want."

"No industry is projected to grow faster through 2020."

13 centers so far

Company founders have invested more than $3 million into the FYZICAL platform.

Since its official launch in October, 13 franchise centers have opened, including clinics in Sarasota and Bradenton. Another nine are in the application process.

The company expects to have 60 franchised clinics -- all independently owned and operated -- open by the end of the year.

Over the next decade, they expect the franchise system to reap $3.2 billion.

Gina Reuillon was in practice for a decade with a physical therapy clinic in Stuart. But with looming health care changes and increased competition, she was forced to downsize in 2012.

Reuillon was among the first to sign on with FYZICAL, purchasing three franchise territories on Florida's East Coast in October.

"I just agreed with everything they put together," she said. "Physical therapists have just not done a good job of marketing or branding what we do.

<p><em>SARASOTA</em> - Terry Nicholson started working for Clockwork Home Services Inc. when the company consisted of four men, a single desk and a few folding chairs in a dusty little St. Louis office.</p><p>Nicholson helped make the provider of air conditioning, plumbing and electrical services a national brand. Eventually, it was sold for $183 million to power company Direct Energy Services.</p><p>Nicholson and a team of brand builders are building again. Only this time they have set their sights even higher -- expanding a national health care franchise that they project will generate $3.2 billion over the next decade.</p><p>Nicholson and his partners are confident their new FYZICAL Therapy and Balance Centers franchise will become the McDonald's of the physical- therapy business. At the same time, they are determined to change the way health care is viewed in America.</p><p>"We're off to a fast start, and we have very ambitious growth goals," Nicholson said from the company's headquarters in the Burns Square area of Sarasota.</p><p>"We intend to change the industry. And I think we even have an outside chance to change the way health care is done entirely."</p><p>Nicholson launched FYZICAL with former Clockwork chief executive Jim Abrams, local physical therapist Keefe Fugleberg and his wife, Lisa Titterud, and physicians Dan and Rhonda Deems.</p><p>The partners hope their new franchise will help independently owned physical-therapy clinics grow the same way Clockwork helped plumbers and electricians across the country.</p><p>If projections hold, they could do just that. The global health care services market is forecast to reach $3 trillion by 2015, according to research from Global Industry Analysts.</p><p>Thanks to an aging world population, the demand for health care is likely to continue climbing in years to come. As that occurs, the industry's focus is expected to shift to preventative care.</p><p>"Physical therapy is evolving -- the more people we can get to understand their bodies better, the more injuries we can prevent," said Tad Fisher, CEO of the Florida Physical Therapy Association.</p><p>"The focus is on how to keep bodies from breaking down, and that will drive costs down."</p><p><b>Filling a need</p><p></b></p><p>Nicholson said he and his partners chose physical therapy because they believe the industry -- and the entire health care system -- are broken.</p><p>He points to statistics that show two-thirds of Americans are considered overweight, one-third are clinically obese, and 1.5 million people in the U.S. die each year from preventable illness.</p><p>Each person who makes up those statistics represents a potential customer for FYZICAL.</p><p>The physical therapy business currently relies on a model that is based on reimbursements from insurance companies for back-end treatment.</p><p>But both Medicare and private insurers are cutting back on reimbursements, even as regulations stiffen, costs rise and competition from hospitals and other physicians groups increases.</p><p>That has left the physical-therapy industry -- with clinics overwhelmingly run by smaller shops -- struggling to stay afloat.</p><p>Nicholson believes creating a unified brand that shifts the focus to a cash-based model for such treatments is the answer.</p><p>"This is a fragmented industry that's composed of a bunch of independents," he said. "We have a business strategy we can apply. Physical-therapy school didn't teach them how to solve business challenges.</p><p>"That's what we're good at -- taking these independents and making them business masters."</p><p>"The science of healing is different than the science of business."</p><p><b>The FYZICAL plan</p><p></b></p><p>FYZICAL's franchising plan includes branding, rights to exclusive balance technologies, marketing material, staff training and other resources.</p><p>By shifting to a cash-based business model, the company hopes to capture more retiring baby boomers, who are living longer, are generally affluent and more active and are willing to pay for prevention through fitness rather than rehab a costly injury like a broken hip.</p><p>Nicholson predicts insurers will eventually follow and fund preventative care to give people an incentive to be healthy.</p><p>That is how most employer-based insurers now see the dental industry, which offers preventative teeth cleanings for nominal costs but charges higher consumer deductibles for treatments like oral surgery.</p><p>Research shows, too, that many consumers do not seem to mind paying out of pocket for services such as teeth whitening, Invisalign braces or porcelain crowns.</p><p>To apply the dental services model to physical therapy, FYZICAL plans to generate increased revenue by opening a series of physical-therapy-based retail shops, which will sell everything from bottled water to protein bars and sweat bands. The company also has developed a new $159 muscular and skeletal exam to get patients in the door.</p><p>Nicholson hopes those strategies will help bolster bottom lines for physical-therapy clinics, which average just $358,000 in annual revenue, records show.</p><p>"America is an aging population, but these retirees are not like my grandma and grandpa," Nicholson said. "They want to live longer, they're active and they spend more to remain healthy. They're willing to invest money to ensure they live the life-style they want."</p><p>"No industry is projected to grow faster through 2020."</p><p><b>13 centers so far</p><p></b></p><p>Company founders have invested more than $3 million into the FYZICAL platform.</p><p>Since its official launch in October, 13 franchise centers have opened, including clinics in Sarasota and Bradenton. Another nine are in the application process.</p><p>The company expects to have 60 franchised clinics -- all independently owned and operated -- open by the end of the year.</p><p>Over the next decade, they expect the franchise system to reap $3.2 billion.</p><p>Gina Reuillon was in practice for a decade with a physical therapy clinic in Stuart. But with looming health care changes and increased competition, she was forced to downsize in 2012.</p><p>Reuillon was among the first to sign on with FYZICAL, purchasing three franchise territories on Florida's East Coast in October.</p><p>"I just agreed with everything they put together," she said. "Physical therapists have just not done a good job of marketing or branding what we do.</p><p>"We need strength in numbers to survive the coming years."</p>